Sandbox:Mydah
Associate Editor(s)-in-Chief: Mydah Sajid, MD[1]
Hyperprolactinemia resident survival guide
Overview
This section provides a short and straight to the point overview of the hyperprolactinemia.
Causes
Life-threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Severe burns on the chest can cause hyperprolactinemia due to neural stimulation similar to suckling. [1]
Common Causes
- Pregnancy
- Lactation
- Prolactinoma
- Injury to dopaminergic neurons in the hypothalamus (sarcoidosis, craniopharyngioma, and metastatic brain carcinoma)
- Section of the hypothalamic-pituitary stalk
- Antipsychotics (risperidone, haloperidol, and phenothiazine)
- Selective serotonin reuptake inhibitors
- Metoclopramide
- Domperidone
- Methyldopa
- Verapamil
- Familial hyperprolactinemia
- Hypothyroidism
- Chronic renal failure
- macroprolactinomas
- Exercise
Evaluation
Shown below is an algorithm summarizing the diagnosis of hyperprolactinemia according to an Endocrine Society Clinical Practice guidelines[2]:
| Suggestive symptoms including headache, oligomenorrhea, infertility, hypogonadism, erectile dysfunction, and galactorrhea | |||||||||||||||||||
| Detailed history and physical examination should be performed to rule out hypothyroidism, chronic renal failure, and the use of medications known to cause hyperprolactinemia. | |||||||||||||||||||
| Serum prolactin measured. The cut-off values of serum prolactin for hyperprolactinemia are greater than 20 ng/ml in men and postmenopausal women and greater than 30ng/ml in premenopausal women. | |||||||||||||||||||
| MRI with the contrast of brain should be performed to rule out any mass in the hypothalamic-pituitary region. | |||||||||||||||||||
| The levels of other pituitary hormones should be evaluated. The following hormone levels should be evaluated: Plasma corticotropins (ACTH), Serum TSH, Insulin-like growth factors, Follicle-stimulating hormone, Luteinizing hormone, Estradiol/ Testosterone | |||||||||||||||||||
Management
The prolactinoma are treated in the following patients[3][2][4]:
| |||||||||||||||||||
| The drug of choice for prolactinoma are dopamine agonists as they decrease prolactin secretion and reduce the size of the prolactinoma.[5][6] Cabergoline is the preferred drug because of its efficacy and lower incidence of nausea and side effects compared to bromocriptine.[7][8] | |||||||||||||||||||
References
- ↑ Morley JE, Dawson M, Hodgkinson H, Kalk WJ (1977). "Galactorrhea and hyperprolactinemia associated with chest wall injury". J Clin Endocrinol Metab. 45 (5): 931–5. doi:10.1210/jcem-45-5-931. PMID 562902.
- ↑ 2.0 2.1 Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA; et al. (2011). "Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 96 (2): 273–88. doi:10.1210/jc.2010-1692. PMID 21296991.
- ↑ Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD; et al. (2006). "Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas". Clin Endocrinol (Oxf). 65 (2): 265–73. doi:10.1111/j.1365-2265.2006.02562.x. PMID 16886971.
- ↑ Melmed S (2020). "Pituitary-Tumor Endocrinopathies". N Engl J Med. 382 (10): 937–950. doi:10.1056/NEJMra1810772. PMID 32130815 Check
|pmid=value (help). - ↑ Vance ML, Evans WS, Thorner MO (1984). "Drugs five years later. Bromocriptine". Ann Intern Med. 100 (1): 78–91. doi:10.7326/0003-4819-100-1-78. PMID 6229205.
- ↑ Wang AT, Mullan RJ, Lane MA, Hazem A, Prasad C, Gathaiya NW; et al. (2012). "Treatment of hyperprolactinemia: a systematic review and meta-analysis". Syst Rev. 1: 33. doi:10.1186/2046-4053-1-33. PMC 3483691. PMID 22828169.
- ↑ Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF (1994). "A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group". N Engl J Med. 331 (14): 904–9. doi:10.1056/NEJM199410063311403. PMID 7915824.
- ↑ Biller BM, Molitch ME, Vance ML, Cannistraro KB, Davis KR, Simons JA; et al. (1996). "Treatment of prolactin-secreting macroadenomas with the once-weekly dopamine agonist cabergoline". J Clin Endocrinol Metab. 81 (6): 2338–43. doi:10.1210/jcem.81.6.8964874. PMID 8964874.